Helping children with cerebral palsy express themselves

dari ChangkatNingkeBTP

Article from The Star Online, Nov 14, 2012


By FARAH A. MOHD ALKAF
(Farah A. Mohd Alkaf is a speech-language pathologist. She will be conducting a workshop for educators and caregivers on Communication And Feeding Needs Of A Child With Cerebral Palsy on Saturday, Dec 1 (9am-1pm), at the Women’s Institute of Management in, Taman Tun Dr Ismail, Kuala Lumpur. For more information, contact Coreen Paul of JPL Training Track at (013) 330-1728 or email coreen@trainingtrack.biz.)

Cerebral palsy is an umbrella term describing a group of disorders that affects body movement, balance and posture. The term cerebral refers to the brain’s two hemispheres and palsy means any disorder that affects control of body movement. There is no problem with the nerves and muscles per se. Rather, cerebral palsy is caused by abnormal development or damage to parts of the brain that control and coordinate movement and posture.

Thus, individuals with cerebral palsy often have difficulty making movements such as (but not limited to) walking, running, climbing, cutting with scissors, eating, speaking or writing. Some individuals severely affected by cerebral palsy may be confined to a wheelchair, while others with mild symptoms may appear only a little uncoordinated.

Many children with cerebral palsy have little difficulty learning and acquiring knowledge. However, because cerebral palsy affects muscle movements in the mouth, it is often difficult for children to communicate what they know and need. So when speech is unclear, many children with cerebral palsy use augmentative or alternative methods to help others understand what they are trying to say.


AAC

Augmentative and alternative communication (AAC) is any communication method used to enhance or provide an alternative to spoken language. AAC systems can be unaided or aided and may include just one system or a combination of systems such as sign language, pictures and photographs, symbols, eye gaze, alphabet boards, speech generating devices, written words or computers.

A child may be taught to use facial expressions, gestures or vocalisations to accompany speech or enhance communication. For example, a child may blink or nod her head to indicate “yes.” She may also be taught to say “ah” or “ya” to accompany those gestures so that her message is clearer. Facial expressions, gestures and vocalisations are examples of an unaided AAC system, which requires no tools. The benefit of using gestures, facial expressions and vocalisations is that these are part of natural human communication and can easily be understood by anyone.

Sign language is another example of unaided AAC. However, sign language requires that a child with cerebral palsy have effective fine motor coordination in order to form those signs with her fingers and may be limited in its use with only communication partners who have been trained to understand those signs.

Some children with cerebral palsy communicate by using low-tech or high-tech AAC systems, which are examples of aided AAC. Low-tech communication devices do not have batteries or use electricity or electronics. A communication board or book has pictures or photographs and written words to communicate anything from different foods that a child wants to eat, to the different activities she wants to participate in. The child may point to a picture with her finger, a light pointer or a mouth/head stick, or she may “point” with her eyes by looking longer at the picture of her choice.

A high-tech communication aid allows messages to be electronically stored and retrieved. A child using a high-tech system may access these messages using a variety of ways such as selecting symbols on a screen using an adapted keyboard, a joystick, mouse or switch. Like the low-tech system, she may also use her finger, a light pointer or a head stick to make choices. Some aids have speech-generating capabilities; some come with a specific set of phrases and words already pre-programmed while others have text-to-speech capabilities, allowing a child to type her own messages. Gadgets such as iPhones, iPads and Android-based phones and tablets can make effective AAC devices with AAC apps available to download for free or for a small fee.

Selecting an AAC system

When selecting appropriate AAC systems, it is important to look at the child’s current abilities, including, but not limited to, posture, fine and gross motor skills, vision, speech, language, communication and educational needs, emotional needs, and caregiver support.

It is equally important to look at the durability, portability and flexibility of the system itself. As the child’s abilities and needs change over time, AAC systems may be modified or adapted to reflect these changes. An interdisciplinary team comprising at least a speech-language pathologist, a physical therapist, an occupational therapist, a learning specialist, a vision specialist and family members help decide on a system that best meets the needs of the child.

Though some children have difficulty speaking, that does not mean that they have nothing to say. With augmentative and alternative communication, children with cerebral palsy have the opportunity to express what they are feeling and what they need, and are thus empowered to develop their own voice and connect with others.